©2003 Community Faculty Development Center Teaching in the Real World Tips for Integrating Learners into Busy Practice Settings November, 2003.

©2003 Community Faculty Development Center

Teaching in the Real WorldTeaching in the Real World

Tips for Integrating Learners into Busy Practice Settings

November, 2003


Our sincere thanks to several hundredexperienced clinical preceptors, residentsand students who have contributed these“Teaching Tips” at faculty developmentworkshops over the last thirteen years


By the end of this session, participants will be able to:

list five new ideas for efficient teaching in busy clinical settings;

demonstrate that they can plan ahead for effective clinical teaching; and

actively participate in clinical teaching to a greater extent than previously

ObjectivesObjectives


Goals Needs Objectives Methods Evaluation

IntroductionIntroduction


Goals Needs Objectives Methods Evaluation

IntroductionIntroduction


There are many things that experienced preceptors ask learners to do that save them time, while adding quality to their practice and teaching

However . . .

This talk is devoted to This talk is devoted to “Methods”“Methods”


Be clear about matching your objectives to the learner’s needs

One learner’s teaching objective may be another learner’s “scut work”

If it doesn’t match, label it as “scut work”

Tell the learner that any time s/he helps to save you will be made up in dedicated teaching time

Say thanks at the end of the dayMethods

Objectivesfeedback

Evaluation

GoalsNeeds

Methods should not drive objectives!Methods should not drive objectives!Objectives should reflect the learner’s needs!Objectives should reflect the learner’s needs!


Clinical teaching is similar to clinical practice You don’t need to do it all at once

Feel free to prioritize Pay attention to educational priorities Pay attention to clinical priorities

How can I teach and How can I teach and practice at the same time?practice at the same time?


Plan ahead Provide an orientation Have learners do things

that save you time and benefit your practice

Learn from your learner Plan how you will use

space Teach on the fly

Scheduling: Tailor the schedule to meet clinical and teaching objectives

Look for unique educational opportunities

Establish guidelines for communication

Tips for using the medical record

General PrinciplesGeneral Principles


If you don’t plan it, it won’t happen Working the student into your schedule

Schedule protected times Formal first-day orientation Mid-point evaluation End of rotation Other protected times for problem-solving, discussion, feedback,

evaluation

Plan other scheduled activities Plan for days when you are not available Offer a menu based on needs, interests

PlanningPlanning


Orient the student Orient your patients Orient your staff Orient yourself

Orientation – four aspectsOrientation – four aspects


Pre-clerkship: Invite the student to visit Is this right for you? Does the student meet certain criteria (e.g. language, etc)

First day: Plan a formal orientation session Prepare a written description of the practice

Have one student prepare a written description to be used with future students

Provide a copy of your mission statement (Community Health Center)

Set up a web site for students; mention them on your practice web site

Orient the StudentOrient the Student


Prepare written guidelines of expectations Logistics: Include specifics about dress, hours, parking, use of

staff areas, food, etc Educational guidelines: Set progressive goals through the weeks Expectations about confidentiality

Provide a learning contract What are your needs? What do you want to learn? List specific learning objectives

Orient the student to your life style Personal

– invite them into your home Professional - hospital, committees, call, etc.

Orient the Student Orient the Student (cont)(cont)


Announce your role Sign in the waiting room Name on the door Handouts, pictures

Invite patients to be teachers Develop a questionnaire (or have a student develop

a questionnaire) Has the student added to the visit?

Provide a business card for the student

Orient your patientsOrient your patients


Make them active participants in the educational planning process

Make it a team approach What can each staff member contribute to the learner’s

education? Have the staff orient the student, give tours Provide an opportunity for the staff to participate in

providing feedback or evaluation

Orient your staffOrient your staff


Introducing the student to the staff At a staff meeting At a social gathering

Introducing the student to patients Plan explicit guidelines with your office staff

How will students be introduced to patients? How will you obtain permission from patients?

Orient your staff Orient your staff (cont)(cont)


Read the curriculum Read the readings Participate in faculty development

Orient yourselfOrient yourself


Tell students that anything they can do to save you time will be made up in active teaching time

Thank the student at the end of the day! Activities that can save you time:

Take vitals, chart notes Talk to patients who are waiting when you are running behind – it’s “better than a

magazine” Write prescription refills Write out patient instructions Go over written patient education materials Make medication lists, ID bracelets Do asthma education Construct a genogram Go through the chart to see if health maintenance guidelines are up to date

Have students do things that save Have students do things that save you time and benefit the practiceyou time and benefit the practice


Working with younger patients: Perform Denver Developmental Testing

Working with older patients: Perform Mini-Mental status exam Interview other caregivers Help elderly patients get dressed and undressed Talk to elderly patients

Procedures – Students need to be allowed to do things Phlebotomy Ear flushing

Have students do things that save you Have students do things that save you time and benefit the practice time and benefit the practice (cont)(cont)


Have a student focus on a puzzling problem Working with a patient or family that has been a puzzle Interview family members Make a home visit Research a difficult clinical issue

Office projects Develop evidence-based medicine resources Develop patient education materials

“Why won’t my baby sleep?” “How big will my baby be?”

Have students do things that save you Have students do things that save you time and benefit the practice time and benefit the practice (cont)(cont)


They may know better . . . Use of a Palm Pilot, technology resources About new drugs, yesterday’s lecture

Personal issues About their culture, their own life experiences

Dealing with clinical questions “ “Take a day, get back to me”

Don’t feel threatened by a student who knows something you don’t know

Don’t confuse knowledge with information

Learn from the StudentLearn from the Student


Provide space for the student: a desk, a shelf, in and out boxes, a TV table, etc.

If an extra exam room is available, you can have the student use it, while you move ahead as needed

Use your consult room for history taking Use your partner’s desk on his/her day off

Rotate desk in a large practice Move phlebotomy to the exam room

Think about the use of spaceThink about the use of space


Have the student see the patient ahead of you Observe the student interview the patient

Try not to interrupt Stand behind the student Stand behind the patient

Have the student present to you in front of the patient

Methods for teaching “on the Methods for teaching “on the fly”fly”


Teaching in front of the patient Works best:

Present the history Skills: Physical exam, procedures Doing patient education Modeling

Use of questioning (vs. “pimping”) Riskier

Complex problem solving Differential diagnosis Bad news

Teaching on the fly Teaching on the fly (cont)(cont)


Schedule events that will help the student Review the schedule ahead of time Review charts ahead of time Double book the first slot, allowing the student to start along with you Specific content areas (e.g. a required H&P): Have a patient come in early

Schedule time with others in the practice Practice partners, Nurse Practitioners, Physician Assistants (one could serve as

coordinator) Office staff

Nurse Health Educator Phlebotomy Health Assistant Billing Clerk Referral Coordinator Receptionist/Appointment Clerk

Scheduling: Tailor the schedule with Scheduling: Tailor the schedule with clinical clinical and and teaching objectives in mindteaching objectives in mind


Schedule time with others outside the practice Consultants in your building Community resources

Nutritionist Social worker, Outreach worker Visiting nurse, Hospice Day care center Adult day care center, Nursing home Pharmacy Health Department Local sheriff, local law enforcement officials

Find respite time Send the student to read up on something that will come up later in the day Encourage the clerkship to schedule out-of-office time Take a second medical student, or a PA or NP student

Schedule with clinical Schedule with clinical and and teaching teaching objectives in mind objectives in mind (cont)(cont)


Share your library, educational resources Identify patients with problems (diabetes, etc.) who

are willing to act as teaching resources Link the student with patients who will present

frequently during the clerkship Newly diagnosed patients, prenatal patients, patients in

crisis, patients in transition Provide a beeper

Take advantage of unique Take advantage of unique educational opportunitieseducational opportunities


Involve the student as you respond to acutely ill patients Have the student phone patients who are acutely ill,

make followup phone calls Use of a speakerphone

Manage fewer acutely ill patients over the phone Have the student prepare for a sick patient who is

coming in Involve the student in after-hours call

Use of a conference-calling feature

Take advantage of unique Take advantage of unique educational opportunities educational opportunities (cont)(cont)


Involve the student in nursing home care Challenge: Continue to see patients until you find three

medications that can be discontinued Have the patient accompany your patients

To see a consultant To have a procedure done To the Radiology Department To OT or PT To accompany the Visiting Nurse



Review phone messages with the student Have the student make the return calls

Have the student review lab work Have the student call patients with results

Community activities write a patient education column for the local paper do a project in the community

Go together Rounds, conferences, even to a deposition



Communicate by phone Share your home phone number Use the practice’s “inside” number

Communicate by email Logistics To provide feedback

Provide an orientation handout

CommunicationCommunication


Have the student do chart reviews, participate in QI projects Have the student type up notes, email them in Regarding Medicare (and in some states, Medicaid)

“The only documentation by medical students that may be used by the teaching physician is their documentation of the review of systems and past, family and social history. The teaching physician may NOT refer to a medical student’s documentation of physical exam finding or medical decision making in his/her personal note.”

AAMC tutorial: “Medicare’s Teaching Physician Documentation Instructions”

Most suggest that medical student notes should not be a part of the permanent record

Some use student notes as prompts

Using the medical recordUsing the medical record


Methods

Objectivesfeedback

Evaluation

GoalsNeeds

But remember:

This session focuses on This session focuses on MethodsMethods

©2003 Community Faculty Development Center Teaching in the Real World Tips for Integrating Learners into Busy Practice Settings November, 2003.

Documents

faculty development

student slide

faculty development

student cont slide

staff cont slide

teaching objectives

clinical practice

teaching tips